Myelodysplastic Syndromes and Fever
Yes, myelodysplastic syndromes (MDS) can cause fever, particularly in patients with neutropenia, and fever should prompt immediate evaluation for infection as it represents a significant cause of morbidity and mortality in these patients. 1, 2
Relationship Between MDS and Fever
- Fever in MDS patients is most commonly associated with infections due to neutropenia, which is a hallmark feature of the disease 2, 3
- Infections occur at a rate of nearly one per patient-year of observation in MDS patients 4
- 31% of MDS patients experience fever/infection episodes, with 19% requiring hospitalization 3
- Fever can also occasionally present as a systemic manifestation of MDS itself (13% of cases with systemic manifestations), though infection should always be ruled out first 5
Risk Factors for Fever in MDS
- Severe neutropenia (ANC < 0.5 × 10^9/L) significantly increases risk of fever/infection (40% vs. 30%) and shortens time to fever/infection (7 vs. 25 months) 3
- Higher-risk MDS (IPSS-R > 3.5) is associated with more fever/infection episodes (36% vs. 29%) and infection-related hospitalizations (24% vs. 14%) 3
- MDS subtype affects infection risk: refractory anemia with excess blasts (RAEB) and RAEB in transformation have higher infection rates than refractory anemia with/without ringed sideroblasts 4
- Hypomethylating agent treatment is associated with higher rates of fever/infection (40% vs. 26%) 3
Management of Fever in MDS
- Rapid initiation of broad-spectrum antibiotics is mandatory in MDS patients with fever or symptoms of infection 1
- Prophylactic antibiotics and/or G-CSF are not recommended for routine neutropenia management in MDS 1
- Short-term use of G-CSF during severe infections may be useful in neutropenic MDS patients, though this indication has not been formally validated 1
- Bacterial pneumonias and skin abscesses are the most common infections in MDS patients 4
Important Clinical Considerations
- Infection is the most common cause of death in MDS patients, accounting for 64% of deaths - more common than transformation to acute leukemia 4
- The presence of systemic vasculitis and/or cryoglobulins in MDS patients with fever is associated with worse prognosis 5
- Multiple immune defects beyond neutropenia may contribute to infection risk in MDS, including impaired neutrophil function and B-, T-, and NK-cell defects 2
- Advanced age, comorbidities, and treatments like hypomethylating agents may further increase infection risk and severity 2, 3
Approach to Fever in MDS Patients
- Fever in an MDS patient should trigger immediate evaluation for infection 1
- Blood cultures, chest imaging, and other site-specific evaluations should be performed based on symptoms 2
- Empiric broad-spectrum antibiotics should be started promptly without waiting for culture results 1
- Consider short-term G-CSF support during severe infections in neutropenic patients 1
- Monitor for response to therapy and adjust antibiotics based on culture results 2